European Multicenter Study of ET-COVID-19
European Multicenter Study of ET-COVID-19
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DOI：
10.1161/strokeaha.120.031514
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发表时间：
2021-01-01
期刊：
影响因子：
8.3
通讯作者：
Costalat, Vincent
中科院分区：
文献类型：
--
作者：
Cagnazzo, Federico;Piotin, Michel;Costalat, Vincent
背景与目的：急性缺血性卒中和大血管闭塞可并发2019冠状病毒病（COVID-19）感染。COVID-19大血管闭塞患者机械取栓（MT）后的结果基本上未知。我们的目的是研究COVID-19患者MT后的早期结果。方法：多中心、欧洲队列研究，涉及法国、意大利、西班牙和比利时的34个卒中中心。数据收集于2020年3月1日至2020年5月5日。纳入连续实验室确诊的COVID-19大血管闭塞患者，并接受MT治疗。主要调查结果：30天死亡率。次要结局：早期神经系统改善（美国国立卫生研究院卒中评分改善>= 8分或24小时美国国立卫生研究院卒中评分0-1分），再灌注成功（脑梗死改良溶栓分级>= 2b），症状性颅内出血。结果：我们评估了93例接受MT治疗的COVID-19大血管闭塞患者（中位年龄71岁[四分位数间距59-79]；63例男性[67.7%]）。预处理国家卫生研究院卒中量表和阿尔伯塔卒中计划早期CT评分的中位数分别为17（四分位数范围11-21）和8（四分位数范围7-9）。前循环急性缺血性脑卒中占93.5%。脑梗死2b ~ 3期改良溶栓率为79.6%（74例[95% CI， 71.3 ~ 87.8]）。30天死亡率为29%（27例[95% CI， 20-39.4]）。早期神经系统改善为19.5%(17例[95% CI， 11.8-29.5])，症状性颅内出血为5.4%（5例[95% CI， 1.7-12.1]）。30天死亡的患者表现出明显较低的淋巴细胞计数，较高的天冬氨酸水平和LDH（乳酸脱氢酶）水平。在调整了年龄、美国国立卫生研究院卒中量表、阿尔伯塔卒中计划早期CT评分和再灌注成功等因素后，这些生物标志物仍然与30天死亡率增加的几率相关（调整后的比值比为淋巴细胞计数每SD-log减少2.70 [95% CI, 1.21-5.98]，天门氨酸每SD-log增加2.66 [95% CI, 1.22-5.77]， LDH每SD-log增加4.30 [95% CI, 1.43-12.91]）。结论：COVID-19患者MT后30天死亡率为29%，不容忽视。淋巴细胞计数、乳酸脱氢酶和天冬氨酸异常可能描述mt后患者预后较差的情况。唯一标识符：NCT04406090。
Background and Purpose: Acute ischemic stroke and large vessel occlusion can be concurrent with the coronavirus disease 2019 (COVID-19) infection. Outcomes after mechanical thrombectomy (MT) for large vessel occlusion in patients with COVID-19 are substantially unknown. Our aim was to study early outcomes after MT in patients with COVID-19.Methods: Multicenter, European, cohort study involving 34 stroke centers in France, Italy, Spain, and Belgium. Data were collected between March 1, 2020 and May 5, 2020. Consecutive laboratory-confirmed COVID-19 cases with large vessel occlusion, who were treated with MT, were included. Primary investigated outcome: 30-day mortality. Secondary outcomes: early neurological improvement (National Institutes of Health Stroke Scale improvement >= 8 points or 24 hours National Institutes of Health Stroke Scale 0-1), successful reperfusion (modified Thrombolysis in Cerebral Infarction grade >= 2b), and symptomatic intracranial hemorrhage.Results: We evaluated 93 patients with COVID-19 with large vessel occlusion who underwent MT (median age, 71 years [interquartile range, 59-79]; 63 men [67.7%]). Median pretreatment National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score were 17 (interquartile range, 11-21) and 8 (interquartile range, 7-9), respectively. Anterior circulation acute ischemic stroke represented 93.5% of cases. The rate modified Thrombolysis in Cerebral Infarction 2b to 3 was 79.6% (74 patients [95% CI, 71.3-87.8]). Thirty-day mortality was 29% (27 patients [95% CI, 20-39.4]). Early neurological improvement was 19.5% (17 patients [95% CI, 11.8-29.5]), and symptomatic intracranial hemorrhage was 5.4% (5 patients [95% CI, 1.7-12.1]). Patients who died at 30 days exhibited significantly lower lymphocyte count, higher levels of aspartate, and LDH (lactate dehydrogenase). After adjustment for age, initial National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and successful reperfusion, these biological markers remained associated with increased odds of 30-day mortality (adjusted odds ratio of 2.70 [95% CI, 1.21-5.98] per SD-log decrease in lymphocyte count, 2.66 [95% CI, 1.22-5.77] per SD-log increase in aspartate, and 4.30 [95% CI, 1.43-12.91] per SD-log increase in LDH).Conclusions: The 29% rate of 30-day mortality after MT among patients with COVID-19 is not negligible. Abnormalities of lymphocyte count, LDH and aspartate may depict a patient's profiles with poorer outcomes after MT.REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT04406090.